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DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Marketing. Costs associated with web design, 10,000.00 10,000.00 <br /> photography, videography, and general promotion of <br /> MBK Orange County. <br /> Totals 134,750.00 134,750.00 <br /> c) To the best of my knowledge and belief all information and data in this application is <br /> true and current. The document has been duly authorized by the governing board of the <br /> applicant. <br /> Signature: <br /> Executive Direc r Dat <br /> 7 <br /> Signature: 60/1" I <br /> Board hairperson Date <br /> AGENCY INFORMATION 1/31/2017 3:24:15 PM Page 8 of 29 <br />